Higher and lower intensity outreach to increase enrollment in a Medicaid food is medicine program: A randomized controlled trial

BACKGROUND: Medicaid accountable care organizations (ACOs) are increasingly implementing Food is Medicine (FIM) programs, but enrollment typically relies on clinicians identifying and referring eligible individuals. Systematic proactive outreach has potential to improve FIM program enrollment. 

OBJECTIVE: Determine the effectiveness of two outreach strategies (letter + telephone (higher intensity) and letter only (lower intensity)) compared to usual care on enrollment into a Medicaid FIM program. 

DESIGN: Three-arm randomized controlled trial conducted at one ACO in eastern Massachusetts between August 2023 and May 2024. 

PARTICIPANTS: Adults and children eligible for Flexible Services (Flex) nutrition services (Medicaid ACO insurance, food insecurity identified on two-item primary care-based screener, eligible diagnosis). 

INTERVENTIONS: The higher intensity group received a letter, followed by telephone outreach, offering Flex enrollment; the lower intensity group received a letter only. The usual care group received no outreach and could be referred by the clinical team. 

MAIN MEASURES: The primary outcome was the proportion of participants enrolled into Flex within 90 days of initial letter outreach, comparing each intervention group vs. usual care and higher vs. lower intensity groups. A secondary outcome was documented receipt of Flex services. 

KEY RESULTS: A total of 255 individuals were randomized. Mean (SD) age was 33 (20) years, with 86 (34%) children; 131 (51%) were female. Compared to usual care, a larger proportion of intervention participants were enrolled in Flex in both the higher intensity (78% vs. 6% [p < 0.001]) and lower intensity (39% vs. 6% [p < 0.001]) groups. Higher intensity was more effective than lower intensity outreach (adjusted difference 39.0%; 95% CI 25.6%, 52.4%). Results were similar in comparisons of receipt of Flex services. 

CONCLUSIONS: Proactive outreach increased enrollment into a Medicaid FIM program. Results suggest higher intensity outreach is most effective, but further research is needed to assess cost-effectiveness to guide implementation in other health systems.